Today we had another set of appointments at Sacred Heart. First we visited the cardiology department where they took a much closer look at her heart to be sure that her condition was not affecting its development. It was a long wait before they took us back. I was expecting some special equipment to be used to view her heart in closer detail, but it was just like the ultrasounds we had already done. The difference was that all of the shots they took were zoomed in on her heart and they did lots of sound recordings of the different valves and things. The doctor came in not long after the tech finished her recordings. She said everything looks great! Everything about Allison's heart looks perfectly normal and healthy except that it is shifted to the right a bit.
We quickly headed to our next appointment back in the fetal medicine department where we spent most of the day our first day at Sacred Heart. They did another full work up ultrasound checking all of her growth and development. We got some really fun pictures of her face at this one. We were to see a different perinatalogist this time, but with the same office. She came in to talk to us about the ultrasound right away. All she had for us was good news!
Allison looks to only have her stomach shifted up and no other organs involved in the herniation. The fact that her liver is down, as you will discover in any CDH research you do, is a huge factor in determining that the severity of her case is on the low end. The doctor said she sees plenty of room on the right side for at least her right lung to develop almost fully. The left lung is still questionable, but one lung is much better than none. It is very common that many organs move up into the chest burdening the growth of both lungs when CDH occurs. Because of the herniation, it is also seen that CDH babies have much smaller abdomen measurements than regular babies. This measurement also helps determine the severity of the case. CDH babies with very good chances have abdominal measurements in the 20th percentile. Allison falls in the 30th! The doctor said that she did not expect such great measurements from a CDH baby.
If these measurements stay the same or get better as the pregnancy progresses, Allison will not require the assistance of ECMO (lung bypass that is only available at level IV NICU's). This would mean that we can have the birth at Sacred Heart instead of in Seattle making everything so much easier! She would still require the immediate surgery to push her stomach down and fix the hole in her diaphragm, but she would simply require the assistance of a ventilator to survive rather than the bypass which Sacred Heart can provide.
Last we met the Nurse Practitioner that will now be handling my OB care. Her name is Kim. It was nice to get to work with someone who plans on continuing our care. A familiar face will be nice as time goes on. She works with patients who's pregnancies involve correspondence between fetal medicine and the general hospitalist OB's. She took the time to get to know us and our case and answered lots of our questions. The specialists are actually suggesting a vaginal birth which surprised us, but they say that the process of birth actually prepares baby to fight for life better than with a C-section. They are however also suggesting a planned birth which involves induction so that everyone can be present when she arrives rather than, if she decides, allowing her to come on a Saturday at mid-night when none of the specialists are there.
Overall it was a great day! Lots of promising information. They will continue to monitor Alli and me closely throughout the pregnancy and of course all plans are subject to change if something comes up. We know all about that! Our next set of appointments are in four weeks to do another full check up, and also to visit with the pediatric surgeons to learn more of what to expect with Alli's arrival.